J Korean Neurosurg Soc.  2011 Sep;50(3):252-255. 10.3340/jkns.2011.50.3.252.

Painless Dissecting Aneurysm of the Aorta Presenting as Simultaneous Cerebral and Spinal Cord Infarctions

• Kwon JY
• Sung JH
• Kim IS
• Son BC

• KMID: 1963619
• DOI: http://doi.org/10.3340/jkns.2011.50.3.252

Abstract

Authors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed hemodynamic cerebral infarction and extensive cord ischemia, respectively. Computerized tomography angiography confirmed a dissecting aneurysm of the descending aorta. The cause of the brain infarction may not have been embolic, but hemodynamic one. Dissection-induced hypotension may have elicited cerebral perfusion insufficiency. The cause of cord ischemia may be embolic or hemodynamic. The dissected aorta was successfully replaced into an artificial patch graft. The arm monoparesis was improved, but the paraplegia was not improved. In rare cases of brain and/or spinal cord infarction caused by painless acute dissecting aneurysm of the aorta, accurate diagnosis is critical because careless thrombolytic therapy can result in life-threatening bleeding.

Keyword

Aorta; Dissecting aneurysm; Cerebral infarction; Spinal cord ischemia

MeSH Terms

Aneurysm, Dissecting*
Angiography
Aorta*
Aorta, Thoracic
Arm
Brain
Brain Infarction
Cerebral Infarction
Diagnosis
Hemodynamics
Hemorrhage
Humans
Hypotension
Infarction*
Ischemia
Magnetic Resonance Imaging
Paraplegia
Paresis
Perfusion
Spinal Cord Ischemia
Spinal Cord*
Spine
Thrombolytic Therapy
Transplants